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      • KCI등재후보

        조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

        김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

        Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

      • KCI등재
      • KCI등재후보

        조혈모세포이식 환자에서 발생한 Cytomegalovirus 질환의 특징 : 일개 대학변원에서 최근 10년간의 경험

        최수미,이동건,박선희,김시현,김유진,민창기,김희제,이석,최정현,유진홍,김동욱,이종욱,민우성,신완식,김춘추 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

        Background : Studies on cytomegalovirus (CMV) diseases in Korean hematopoietic stem cell transplant (HSCT) recipients are lacking and do not reflect the recent trends of advances and changes. Therefore, we tried to analyze the clinical features of CMV diseases in HSCT recipients over the past 10 years at a tertiary university hospital in Korea. Methods : Retrospective review of medical records was done for all adult HSCT patients who received transplant at the Catholic HSCT Center from January 1998 to January 2008. Results : Forty-four cases (2.2%) of CMV diseases were identified. CMV pneumonia was diagnosed in 17 patients, retinitis in 16 patients, enterocolitis in 7 patients, esophagitis 1 patient, gastritis in 1 patient, duodenitis in 1 patient, and hepatitis in 1 patient. The median onset of symptom was 90 days after transplantation. Late CMV diseases accounted for 47.7%. CMV related death varied from 0 to 58.8% according to the involved organ. CMV retinitis was diagnosed relatively later in the course of transplantation mostly in patients who had chronic graft versus host disease (GVHD). On the contrary, CMV enterocolitis mainly occurred in patients who suffered from acute GVHD. The overall concurrent CMV reactivation was documented to be 63.6%: the concurrent CMV reactivation was observed only in 37.5% of patients with retinitis. Conclusions : We observed some differences in the pattern of CMV disease manifestation according to the involved organ and reconfirmed the fact that CMV pneumonia is the most common and fatal disease in HSCT recipients. Additionally, CMV retinitis was not uncommon in HSCT recipients. Since specific marker does not exist in predicting retinitis, regular ocular examination should be done thoroughly, especially in patients with chronic GVHD.

      • 乳房炎 乳汁에서 分離된 原因菌의 抗菌劑 感受性

        崔民淳,金鍾冕,趙正坤,蔡孝錫,姜明大,宋熹鍾 全北大學校 附設 畜産開發硏究所 1987 畜産開發硏究報告 Vol.1 No.-

        A total of 189 strains (Streptococcus agalactiae and non-Streptococcus agalactiae 110, Staphylococcus aureus 63, and E. coli 16) isolated from bovine mastitie milk samples by "The Connecticut Mastitis Control Program" in dairy herds were examined for drug susceptibility to 8 drugs and analysed the rate of multiple resistant patterns. 1. All of the isolates were resistant to antimicrobial agents such as penicillin (PC), streptomycin (SM), kanamycin(KM), carbenicillin (CA), lincomycin (LM), gentamicin (GM), and tetracycline (TC), singly or multiply. The isolates were more susceptible to CA (84.1%),PC (78.9%), and SM (78.4%) than the the other drugs such as GM (51.8%), KM (48.7%), TC (19.6%) and LM (19.0%) in order. 2. The multiple resistant isolates (96.3%) were more than those of singly resistant isolates (3.7%) and 58 different drug resistant patterns were observed. Among 7 singly resistant isolates, CP was the commonest. While among 182 multiple resistant isolates, CP-KM-LM-TC-GM, CP-LM-TC, CP-LM-TC-GM, PC-CP-SM-LM-TC-GM, CP-KM-LM-TC, and CP-LM patterns were frequently encounted. 3. The strains of streptococcus spp. were more susceptible to CA (90.1%) and SM (82.9%) than the other drugs such as KM (43.2%), GM (38.7%), LM (13.5%), CP (10.8%) and TC (10.8%). Among them CP-KM-LM-TC-CM pattern was frequently encounted. 4. The strains of Sta. aureus were more susceptible to PC (74.6%),CA (69.8%), SM (65.1%) and GM (63.5%) than the other drugs such as KM (46.0%), CP (22.2%), TC (15.9%) and LM (9.5%). Among them CP-LM-TC pattern was commonly encounted. 5. The strains of E. coli were more susceptible to CA (100%) and KM (75.0%) tnan TC (9.5%). But the other drugs such as PC, SM, GM, CP and LM were not. Among them PC-CP-SM-LM-TC-GM pattern was commonly encounted.

      • 막스 프리쉬의『학교수업을 위한 빌헬름 텔』(Wilhelm Tell fu¨r die Schule)에 나타난 텔신화의 파괴

        최석희 대구효성가톨릭대학교 외국어문학연구소 1990 語文學硏究 Vol.3 No.-

        Max Frisch Vero¨ffentlichte 1971 seine Variante der Tellgeschichte "Wilhelm Tell fu¨r die Schule", die mit der Absicht verfaβt worden ist, den schweizerischen Nationalmythos zu zersto¨ren. In dieser Arbeit wird anhand von Max Frischs Wilhelm Tell die Zersto¨rung des schweizerischen Mythos aufgezeigt. Zuerst wird die Intention in Max Frischs Wilhelm Tell behandelt. Frisch zersto¨rt den Nationalmythos, um dadurch die Schweizer zu kritisieren, die Tell als ihr Nationalhelden ansehen. Max Frisch zersto¨rt die Legende des Wilhelm Tell durch die Psychologisierung der Personen.: In Geβler wird beim Leser das Feinbild zersto¨rt. Und aus dem Ra¨cher Tell wird ein ganz banaler Mo¨rder. Eine treibende Kraft der Handlung sind Miβversta¨ndnisse. Die Dinge bedingen sich nicht zwangsla¨ufig aus einer Ordung heraus, sondern die Handlung wird eher zufa¨llig vorangetrieben. Der Apfelschuβ kommt nur zustande, weil ein Witz falsch verstanden wurde. Die Wortwahl ist banal und getragen von Kleinigkeiten. Wo¨rter wie "Ka¨se", "Kopfschmerzen", "Schieβfliegen", "Langeweile" und "Kuhglocke" pra¨gen die Erza¨hlung. Durch das Wortmaterial und durch den Sprachstil gelingt dem Autor die Ironie, die den ganzen Text durchzieht. Die Schweizer sind stolz und Fremden gegenu¨ber sehr unfreundlich. Frisch gibt zu bedenken, daβ dies noch heute in der Schweiz weit verbreitet sei. Die erhabenen Berge und das harmonische La¨uten der Kuhglocken in Schillers Drama werden in Frischs Erza¨hlung eher zu bedrohenden Elementen. Als letztes Beispiel fu¨r die Zersto¨rung der Legende bei Frisch mo¨chte ich auf die Anmerkungen eingehen, die den gesamten Text durchziehen. Frisch benutzt die Anmerkungen, um den Tellmythos in Frage zu stellen, aber auch, um die Geschichte zu aktualisieren. Ein genauer Vergleich zwischen Schillers "Wilhelm Tell" und dem "Wilhelm Tell fu¨r die Schule" von Max Frisch ist kaum mo¨glich, da die Intentionen der beiden Autoren grundverschieden waren. Schiller wollte ein Drama scheiben, welches einen Mythos verherrlichen sollte, wa¨hrend Max Frisch die Tell-Legende zersto¨ren wollte. Ob heute in der Schweiz Schillers Tell gegenwa¨rting ist oder Frischs Tell aktuell ist, wollte Frisch wissen. Auf jeden Fall hat Frisch dazu beigetragen, daβ die Tell-Legende heute etwas kritischer gesehen wird und den Platz eingenommen hat, der ihr gebu¨hrt.

      • 최근 일본에서의 헤세 수용

        최석희 한국헤세학회 2002 헤세연구 Vol.8 No.-

        In deiser vorliegenden Arbeit soll die Rezeption Hermann Hesses in Japan in den letzten Jahren erforscht werden. In den 30er und 40er Jahren sind die meisten Werke Hesses ins Japanische u¨bersetzt worden. Peter Camemzind, Unterem Rad, Siddahartha, Demian, Narzis und Goldmund und Gertrund sind am meisten gelesen. Hesse war einer der beliebtesten europa¨ischen Autoren. Aber Hesse wurde nur als 'sentimentaler Idylliker' und 'unzeitgema¨sser Dichter' bewertet. Von seinen spa¨teren Werken wird das Glasperlenspiel nicht viel gelesen, obwohl der Wert dieses Romans von den Literaturkritiker anerkannt ist. In den 70er Jahren wurde besonders Steppenwolf von Hesses Werken in den USA sehr beliebt. Aber nur wenige Japaner machten die Mode der steppenwo¨lfisch - anarchistischen Hesse-Rezeption in Amerika mit. Seine Popularita¨t war in Japan nur auf die fru¨hen Werke beschra¨nkt. Die Zahl der Jugendlichen, die seine Bu¨cher in die Hand nehmen, nimmt ab. Trotzdem begann im Jahr 1995 eine Art Hesse-Revival. Ein Verlag, Soshisa, hat fu¨r die a¨lteren Leserschichten Mit der Reife wird man immer ju¨nger u¨bersetzten lassen und das hatte einen Erfolg u¨ber Erwarten gahabt. Seitdem wird in Japah 'der alte, weise Hesse' als neues bild immer deutlicher. Mehrere Sammlungen von Hesses kleinen Essays sind erschienen: Freude am Garten(1996), Tessin(1997), Wer lieben kann, ist glu¨chlich(1998), die Ho¨lle ist u¨berwinderbar. Daneben sind ausgewa¨hlte Briefe, eine Sammlung von Aufsa¨tzen und Essays u¨ber Hermann Hesse erschienen. Die Briefba¨nde trugen bei japanischen Lesepublikum zur Feststelling bei, Hesse sei auch ein nu¨chterner Realist gewesen, der wa¨hrend der beiden Weltkriege seine nonkonformistische Einstellung gegen den Krieg durchsetzte. In den letzten zehn Jahren ist fast keine Neuu¨bersetzung von Hesses Hauptwerken erschienen. Dennoch bewahrt Hermann Hesse in Japan immer noch den Ruhm des beru¨hmtesten ausla¨ndischen Autors. Hesse ist immer noch einer der meist gelesenen ausla¨ndischen Autoren in Japan.

      • 양측성 관상동정맥루 1예

        최용원,오석규,이재훈,이상재,권경희,최은경,김남호,정진원 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.1

        저자들은 호흡곤란, 흉부불쾌감, 심계항진 등을 주소로 내원한 환자에서 경흉부 및 경식도 심초음파 검사상 주폐동맥에서 이완기에 전행하는 지속적인 혈류의 흐름을 관찰하고, 관상동맥 조영술을 통해 좌전하행지 중간부위와 우관상동맥 근위부에서 각각 기시하여 공통경로를 이루면서 주폐동맥으로 유입되는 양측성 관상동정맥루를 보이는 드문 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. A coronary arteriovenous fistula is infrequently encountered vascular communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common congenital anomaly that can affect coronary perfusion. Bilateral involvement of coronary fistula constitutes an uncommon subgroup of coronary arteriovenous fistulas. A 69 year-old female patient presented with chest discomfort, palpitation, and dyspnea. In the echocardiography, doppler color flow imaging visualized abnormal flow signals with mosaic appearance in the main pulmonary artery during diastolic phase. Coronary angiography revealed arteriovenous fistula arising from the left anterior descending artery and the right coronary artery. Both coronary arteriovenous fistulas drained into the main pulmonary artery. We report a case of bilateral coronary arteriovenous fistula that was confirmed by echocariography and coronary angiography.

      • 다약물 내성기전으로서 ABC transporter와 화학감작제의 개발

        최철혁,권대승,최석민 朝鮮大學校 附設 醫學硏究所 2002 The Medical Journal of Chosun University Vol.27 No.2

        Anticancer resistance is one of the major problems in the clinical cancer chemotherapy. Of resistance mechanisms are ATP (ATP-binding cassette) transporters including P-glycoprotein. In this paper, ABC transporters with respect to the physiological functions and multidrug resistance mechanisms as well as the development of chemosensitizers for their reversal have been reviewed.

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